ED vs. ICU

Looking for opinions and rationales as to why one area is better than the other for a nurse with an established med/surg background looking into critical care. Honestly, if I was offered an opportunity to do either I would take it in a heartbeat, but in the off chance I had a choice between the two (specifically cardiac icu), I'm torn.

One area is not better than another, how you like it depends on you.
How much routine do you like? I am a creature of habit and like a certain amount of structure in my day. I know in ICU that I will have 1 or 2 patients, they will be assessed Q2 hrs, first set of meds is at 0900, the doctors round at the same time every day etc. My patients are all adults, and except for the occasional overflow from another unit, will be surgical patients.
If I moved to ED, my patients would be all ages and any medical condition. I will start my shift having few or many patients, there is less predictability here and I would need to be able to change plans and shuffle priorities frequently.

Mar 4, '13

I think it also depends on your ultimate goal. If you ever want to further your education you should consider which would be best for that. ER or ICU would both present challenges. See if you could shadow in each to decide which you prefer.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

Mar 4, '13

Thank you! I love unpredictability, shifting modes. It keeps me excited about my job. However, I want to pursue a specialty where I can learn a lot, and be intellectually challenged. I feel I could learn much in either job, but I'm less convinced that Ed nurses become "experts"about certain conditions like a specialty ICU nurse could. But maybe I'm wrong?

Mar 4, '13

I have worked both and LOVE both. They are both very different and are unique specialties. You will become an expert in both places but for different reasons. Remember the ICU patients for the most part have come through the ED.

In the ED there is less invasive monitoring if there is moitoring at all (aline,PA lines,ICP, balloon pumps) In the ED you are a master of all trades....from a chin lac to a major trauma to cracking a chest to thrombolytics. But you interaction with the patients is limited. In the ED it is treat em and street em...there is a lot of....shall I say, less desirable aspects of life like the criminals, drunks, drug seekers, and just plain donkey behinds.

ICU pfferes a longer and more "intimate" relationship with the patients. Depending on the ICU your population can be very diversified to specific like a CTPACU (cardio/thorasic recovery/post op).

ICU has much more day to day care, intense assessment head to toe, while the ED is a focused assessment on the problem at hand to send them to their destination.

You will either like it or hate it. Some ICU don't make good ED nurses many ED nurses don't like ICU ....I liked them both. I like the ADHD of the ED and the rapid fire turn over knowing that tomorrow they will not be there in the same room.....but I LOVE sick open hearts, pedi and neuro and the interpretation of the information for the invasive monitoring and planning my course of actin from there to stabilize someone. I liked seeing them go from being sick and getting better to leave and go home.

I once had the perfect job (Thanks MAK) where I did both.

Mar 4, '13

Like others have said neither is better than the other. ED and ICU are two totally different beasts. I've tried to work in CVICU and ED and neither was a good fit for me. I'm not a person that handles unpredictability and that kind of stress well. In your case, you seem like you have the personality for both. ICU is challenging, you will be required to look at the whole picture rather then chief complaint. You will be managing very sick patients on mulitiple drips, vents, catheters, and drains. ICU is very intense. You can have 1-3 patients and sometimes your patients do become unpredictable and you have to fix it.
ED is fast paced and all about "moving the meat". The patient either goes home, to the morgue or to the floors. You will have all different ages and people come through the door. How are you will babies/kids/ and the elderly? How do you feel about the homeless, drug seekers and alcholics? How about women in labor or pediatric clients. In the ED you are in all in one and will see it all. Many times ED nurses see all the things people who work the floors don't see because many patients are discharge from the ED. The ED requires thinking on your feet, good IV skills, able to keep calm in the storm. You will be challenged but just in a different way than ICU. Your main goal for the ICU patient is to stabalize them and get them to the ICU ASAP so that the ICU nurses and intensavists can develop a more indepth plan of care.
You will laugh alot in the ED, and it is never a dull moment. The ICU is more intense and more quiet but hopefully you will have supportive co-workers through it all.
Perhaps trauma ICU after you get ICU experience will be an option. Best of both worlds?Maybe.
Ask for a share day in both to help you make a more informed decision.
Good luck to you. Let us know what you choose!!!

Mar 4, '13

I agree with shadowing both as they are two completely different areas. ER nursing and floor (ICU) nursing are different in many aspects already named above. I have worked in an ER/trauma my entire nursing career and could not imagine being on the floor/ICU. I enjoy the fast pace, the stress, the fact that we see all ages and all different complaints. I love truly doing life saving measures! I also enjoy that the doctors seem to be more down to earth with the nurses (at least everywhere I have worked at). They also learn to respect you assessment - If you say you need a doctor in a room STAT....they know it means STAT! What I don't enjoy as much is the disrespect you get from many patients and family members, the drug seekers and alcoholics can burn you out. I also feel like I am missing out on a certain area of education/skills that ICU nurses have such as the art lines, vents, etc. You have to evaluated what you are looking for in your career and what will provide you with the most personal satisfaction. The great thing about nursing - you can go many places with your career.

Mar 5, '13

Sure you can have specialties in the ER. I've known a few to specialize in peds, and have the certification behind it CEN-P. Some are the go-to person for cardiac knowledge. I once did SANE exams with adults and peds, which is another specialization with extra education and certification.

Mar 6, '13

Sorry, I forgot about the specialization with trauma and peds trauma.

Mar 6, '13

I have worked both and they both have their ups and downs. It is probably to move from the ICU to the ER than the other way. Your ICU knowledge is probably more knowledge based and ER more experience based. In the ER you have to be very flexible, and be willing to let tasks be deferred to the floor. That goes against wanting to finish every task but sometimes there just isn't time. Good luck.

Thank you! I love unpredictability, shifting modes. It keeps me excited about my job. However, I want to pursue a specialty where I can learn a lot, and be intellectually challenged. I feel I could learn much in either job, but I'm less convinced that Ed nurses become "experts"about certain conditions like a specialty ICU nurse could. But maybe I'm wrong?

Your good Er nurses become expert at a lot of conditions, in the Er you must know a lot about a lot of different things

Mar 8, '13

Different areas, neither "better" than the other. If you love details & have some ocd, head for the unit. If you love unpredictability & have some adh oh look, a squirrel, then head for the ed.

The unit & er are players on the same team.

Mar 16, '13

In a big ED, you will get some experience with invasive monitoring, drips, etc because the units are sometimes full so we end up boarding patients for quite a few hours.

One thing I like about the ED is that we have regular interaction with the docs, who are generally very friendly and helpful, and always willing to teach.

And when things go to crap, I can have three docs (attending, R1 and R3) in the room in under a minute - even at the microhospital, I had a doc nearby all the time.